Nursing Diagnoses Definitions and Classification 2018-2020 Eleventh Edition Barbara Bate RN-BC, CCM, CNLCP, CRRN, LNCC, MSCC
Objectives Attendees will be able to identify new, revised, and retired nursing diagnoses. Attendees will be able to define "nursing diagnosis" and describe how to utilize one, or more, in a life care plan. Attendees will be able to explain the "structure of the nursing diagnosis statement" when included in a care plan
Definitive guide to nursing diagnoses, as reviewed and approved by NANDA International.
NANDA-International (NANDA-I) Member-driven grassroots organization committed to the development of nursing diagnostic terminology Desired outcome of their work is to provide nurses at all levels and in all areas of practice with a standardized nursing terminology
NANDA-International (NANDA-I) International networks in Brazil, Columbia, Ecuador, Italy, Mexico, Nigeria-Ghaua, Peru, Portugal, as well as a German language group Collaborative links with nursing terminology societies throughout the world, including the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC)
NANDA-International (NANDA-I) Mission: To facilitate the development, refinement, dissemination, and use of standardized nursing diagnostic terminology Provide the world s leading evidence-based nursing diagnoses for use in practice and to determine interventions and outcomes Provide funding for research through NANDA-I Foundation Global network of nurses committed to improving the quality of nursing care through evidence-based practice
NANDA-International (NANDA-I) Diagnoses used internationally Translated into nearly 20 languages
What s NEW? All introductory chapters written at undergraduate nursing level providing the critical information needed for nurses to understand assessment, it s link to diagnosis and clinical reasoning, and the purpose of use of taxonomic structure for nurses.
What s NEW? 17 new nursing diagnoses 244 Approved Nursing Diagnoses 72 revised diagnoses Removal of 8 nursing diagnoses Updates to 11 nursing diagnosis labels
What s NEW? Modifications to the vast majority of nursing diagnosis definitions, including Risk Diagnoses Standardization of diagnostic indicator terms (e.g., defining characteristics, related factors, risk factors, associated conditions, and at-risk populations) to further aid clarity for readers and clinicians
What s NEW? Coding of all diagnostic indicator terms for those using electronic versions of the terminology Web-based resources that include chapter and reference lists for nursing diagnoses (http://media.center.thieme.com or www.thieme.com/nanda-i Need to set up account and provide access code from first page of book)
What s NEW? Changes to definition of Health Promotion Diagnoses Added At-Risk populations and Associated Conditions
Nursing Process Assessment, nursing diagnosis, outcome identification, planning, implementation, and evaluation Common thread among all nursing specialties Forms the foundation of our decision making and evidencebased practice in life care planning
NANDA-I Regardless of setting or unit, professional nurses should always be assessing patients, considering diagnoses related to the needs, identifying relevant outcomes, and implementing interventions. Without proper nursing assessment, there can be no patientcentered nursing diagnosis, and without an appropriate nursing diagnosis, there can be no evidence-based, patient-centered, independent nursing interventions.
Nursing Diagnosis A clinical judgment concerning a human response to health conditions/life processes, or vulnerability for that response, by an individual, family, group, or community (NANDA-I, 2013) Nurses diagnose health problems, risk stakes, and readiness for health promotion
Nursing Diagnosis A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability (Approved 9 th NANDA Conference; amended in 2009 and 2013) A nursing diagnosis is a judgment based on a comprehensive nursing assessment. The medical diagnosis provides one important piece of data, but it does not provide anywhere near the depth of information necessary for making an accurate nursing diagnosis.
Nursing Diagnosis Problem-Focused Nursing Diagnosis A clinical judgment concerning an undesirable human response to health conditions/life processes that exists in an individual, family, group, or community Health Promotion Nursing Diagnosis A clinical judgment concerning motivation and desire to increase well-being and to actualize health potential
Nursing Diagnosis Risk Nursing Diagnosis A clinical judgment concerning the susceptibility of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes Syndrome A clinical judgment concerning a specific cluster of nursing diagnoses that occur together, and are best addressed together and through similar interventions
Each nursing diagnosis has: Nursing Diagnosis A diagnosis label and a clear definition Diagnostic indicators (e.g., defining characteristics, related factors and/or risk factors) New: At risk populations and associated conditions
Nursing Diagnosis Domains Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Domain 6 Health Promotion Nutrition Elimination and exchange Activity/rest Perception/cognition Self-perception
Nursing Diagnosis Domains Domain 7 Domain 8 Domain 9 Domain 10 Domain 11 Domain 12 Domain 13 Role relationship Sexuality Coping/stress tolerance Life principles Safety/protection Comfort Growth/development
Nursing Diagnosis Class Diagnoses are further sorted by Class within each Domain For Example: Sedentary Lifestyle is listed in Domain 1 (Health Promotion) and Class 1 (Health Awareness)
Nursing Diagnosis Common Format when writing a nursing diagnosis: (nursing diagnosis) related to (cause/related factors) as evidenced by (symptoms/defining characteristics).
Nursing Diagnosis Impaired physical mobility related to pain as evidenced by alteration in gait, decrease in gross motor skills, decrease in reaction time, discomfort, and slowed movement. Impaired physical mobility- Limitation in independent, purposeful physical movement of the body or of one or more extremities related to pain as evidenced by alteration in gait, decrease in gross motor skills, decrease in reaction time, discomfort, and slowed movement.
Health Promotion Diagnosis Change A clinical judgment concerning motivation and desire to increase well-being and to actualize health potential. These responses are expressed by a readiness to enhance specific health behaviors, and can be used in any health state. In individuals who are unable to express their own readiness to enhance health behaviors, the nurse may determine that a condition for health promotion exists and act on the client s behalf. Health promotion responses may exit in an individual, family, group, or community.
Domain 1: Health Promotion Class 1: Health Awareness New Diagnoses Readiness for enhanced health literacy Diagnosis Code 00262
New Diagnoses Domain 2: Nutrition Class 1: Ingestion Ineffective adolescent eating dynamics, Diagnosis Code 00269 Ineffective child eating dynamics, Diagnosis Code 00270 Ineffective infant eating dynamics, Diagnosis Code 00271
New Diagnoses Domain 2: Nutrition Class 4: Metabolism Risk for metabolic imbalance syndrome, Diagnosis Code 00263
Domain 4: Activity/Rest Class 3: Energy Balance New Diagnoses Imbalanced energy field, Diagnosis Code 00273
New Diagnoses Domain 4: Activity/Rest Class 4: Cardiovascular/pulmonary responses Risk for unstable blood pressure, Diagnosis Code 00267
New Diagnoses Domain 9: Coping/Stress Tolerance Class 1: Post-trauma responses Risk for complicated immigration transition, Code 00260 Diagnosis
New Diagnoses Domain 9: Coping/Stress Tolerance Class 3: Neurobehavioral Stress Neonatal abstinence syndrome, Diagnosis Code 00264
New Diagnoses Domain 9: Coping/Stress Tolerance Class 3: Neurobehavioral Stress Acute substance withdrawal syndrome, Diagnosis Code 00258
Domain 9: Coping/Stress Class 3: Neurobehavioral Stress New Diagnoses Risk for acute substance withdrawal syndrome, Code 00259 Diagnosis
Domain 11: Safety/Protection Class 1: Infection New Diagnoses Risk for surgical site infection, Diagnosis Code 00266
Domain 11: Safety/Protection Class 2: Physical Injury New Diagnoses Risk for dry mouth, Diagnosis Code 00261
Domain 11: Safety/Protection Class 2: Physical Injury New Diagnoses Risk for venous thromboembolism, Diagnosis Code 00268
Domain 11: Safety/Protection Class 3: Violence New Diagnoses Risk for female genital mutilation, Diagnosis Code 00272
Domain 11: Safety/Protection Class 4: Environmental Hazards New Diagnoses Risk for occupational injury, Diagnosis Code 00265
Domain 11: Safety/Protection Class 6: Thermoregulation New Diagnoses Risk for ineffective thermoregulation, Diagnosis Code 00274
72 Revised Diagnoses Changes were made in order to be: Consistent with current literature Reflect a human response Clarify concepts Congruent with similar diagnoses Consistent with new guidelines
Revisions to 11 Nursing Diagnosis Labels Diagnosis Label Provides a name for a diagnosis that reflects, at a minimum, the focus of the diagnosis and the nursing judgment. It is a concise term or phrase that represents a pattern of related cues and may include modifiers. Changes were made to ensure that the: Diagnostic label was consistent with current literature Reflected a human response
Previous Diagnostic Label Deficient diversional activity (00097) Insufficient breast milk (00216) Neonatal jaundice (00194) Risk for neonatal jaundice (00230) Impaired oral mucous membrane (00045) Risk for impaired oral mucous membrane (00247) New Diagnostic Label Decreased diversional activity engagement Insufficient breast milk production Neonatal hyperbilirubinemia Risk for hyperbilirubinemia Impaired oral mucous membrane integrity Risk for impaired oral mucous membrane integrity
Previous Diagnostic Label Risk for sudden infant death syndrome (00156) Risk for trauma (00038) Risk for allergy response (00217) Latex allergy response (00041) Risk for latex allergy response (00042) New Diagnostic Label Risk for sudden infant death Risk for physical trauma Risk for allergic reaction Latex allergic reaction Risk for latex allergic reaction
Retired Diagnoses Nursing Diagnosis Risk for disproportionate growth (00113), Domain 13, Class 1 Noncompliance (00079), Domain 1, Class 2 Reason for Retirement Pediatric nurses encouraged to consider reconceptualization of this diagnosis and to present it to NANDA-I as a new diagnosis Old diagnosis, last revised in 1998. No longer consistent with majority of current research, which now has focus of adherence vs. compliance
Retired Diagnoses Nursing Diagnosis Readiness for enhanced fluid balance (00160), Domain 2, Class 5 Readiness for enhanced urinary elimination (00166), Domain 3, Class 1 Risk for impaired cardiovascular function (00239), Domain 4, Class 4 Reason for Retirement Lacks sufficient evidence to support continuation within the terminology Lacks sufficient evidence to support continuation within the terminology Lacks sufficient differentiation from other cardiovascular diagnoses within the terminology
Retired Diagnoses Nursing Diagnosis Risk for ineffective gastrointestinal perfusion (00202), Domain 4, Class 4 Risk for ineffective renal perfusion (00203), Domain 4, Class 4 Risk for imbalanced body temperature (00005), Domain 11, Class 6 Reason for Retirement Not found to be independently modifiable by nursing practice Not found to be independently modifiable by nursing practice Replaced by new diagnosis, Risk for ineffective thermoregulation (00274).
New Diagnostic Indicator Categories At-Risk Populations: Groups of people who share a characteristic that causes each member to be susceptible to a particular human response, such as: demographics, health/family history, stages of growth/development, or exposure to certain events/experiences
New Diagnostic Indicator Categories Associated Conditions: Medical diagnoses, injuries, procedures, medical devices, or pharmaceutical agents. These conditions are not independently modifiable by the professional nurse, but may support accuracy in nursing diagnosis
Impaired Home Maintenance Domain 4, Class 5, Diagnosis Code (00098) Definition: Inability to independently maintain a safe growthpromoting immediate environment. Defining Characteristics (listed) Related Factors (listed) At Risk Population-Financial crisis Associated Condition: Alteration in cognitive functioning
Impaired Home Maintenance Domain 4, Class 5, Diagnosis Code (00098) This diagnosis will retire from NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher.
NANDA-I Needs Your Help Nursing Diagnoses developed prior to 2002 do not list a level of evidence Were grandfathered into the taxonomy in 2002, with those not meeting criteria targeted for revision or removal over next few editions
NANDA-I Needs Your Help The last of those nursing diagnoses (>50) are slotted for removal in next edition unless additional work is done on them
NANDA-I Needs Your Help Most require additional level of evidence Need for related/risk factors Need for definition clarification Need to differentiate from another similar diagnosis (e.g., impaired wheelchair mobility and impaired physical mobility)
NANDA-I Needs Your Help NANDA-I is focusing on revision of these diagnoses Encouraging nurses to work on older diagnoses to bring them to a minimum level of evidence (and raising level of evidence of others) v. submitting new diagnoses
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Ineffective health maintenance Ineffective family health management Ineffective protection Imbalanced nutrition Impaired swallowing Risk for impaired liver function
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Risk for imbalanced fluid volume Deficient fluid volume Risk for deficient fluid volume Impaired urinary elimination Functional urinary incontinence Reflex urinary incontinence Urinary retention
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Constipation Risk for constipation Perceived constipation Diarrhea Bowel incontinence Impaired gas exchange Sleep deprivation
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Risk for disuse syndrome Impaired bed mobility Impaired wheelchair mobility Fatigue Wandering Activity intolerance Risk for activity intolerance Decreased cardiology output
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Risk for decreased cardiac output Impaired spontaneous ventilation Risk for ineffective cerebral tissue perfusion Dysfunctional ventilatory weaning response Impaired home maintenance Unilateral neglect Deficient knowledge Impaired verbal communication
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Hopelessness Situational low self-esteem Risk for situational low self-esteem Disturbed body image Impaired parenting Risk for impaired parenting Interrupted family processes Parental role conflict
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Ineffective role performance Impaired social interaction Post-trauma syndrome Risk for post-trauma syndrome Rape-trauma syndrome Relocation stress syndrome Risk for relocation stress syndrome Anxiety
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Ineffective coping Ineffective community coping Readiness for enhanced community coping Compromised family coping Readiness for enhanced family coping Fear Grieving Chronic sorrow
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Autonomic dysreflexia Risk for autonomic dysreflexia Decreased intracranial adaptive capacity Disorganized infant behavior Risk for disorganized infant behavior Readiness for enhanced organized infant behavior Ineffective airway clearance Risk for aspiration
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Impaired dentition Risk for falls Risk for injury Risk for peripheral neurovascular dysfunction Risk for physical trauma Risk for shock Risk for suffocation
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Risk for other-directed violence Risk for self-directed violence Self-mutilation Risk for self-mutilation Risk for suicide Latex allergy reaction Risk for latex allergy reaction Impaired comfort
Additional Nursing Diagnoses Set to Retire (if no additional work is completed) Readiness for enhanced comfort Chronic pain syndrome Labor pain Social isolation Risk for delayed development
THANK YOU!!! Barbara Bate RN-BC, CCM, CNLCP, CRRN, LNCC, MSCC Northeast Life Care Planning, Inc. (877) 843-5729 bbate@nlcp.net